Provider Demographics
NPI:1578881595
Name:ROSE JULIA RIORDAN TRANQUILITY VILLAGE
Entity Type:Organization
Organization Name:ROSE JULIA RIORDAN TRANQUILITY VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-357-5261
Mailing Address - Street 1:559 MENDOCINO CT
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4230
Mailing Address - Country:US
Mailing Address - Phone:209-357-5200
Mailing Address - Fax:209-357-5279
Practice Address - Street 1:559 MENDOCINO CT
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4230
Practice Address - Country:US
Practice Address - Phone:209-357-5200
Practice Address - Fax:209-357-5279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY SOCIAL MODEL ADVOCATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240001EN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility